本文選題：糖尿病 + 骨關(guān)節(jié)炎��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探究一般資料及生化指標(biāo)在2型糖尿病伴骨關(guān)節(jié)炎(膝關(guān)節(jié))發(fā)生、發(fā)展的作用及相關(guān)性,為糖尿病骨關(guān)節(jié)炎的臨床診斷與治療提供理論依據(jù)。[方法]收集2014年10月至2016年12月在昆明醫(yī)科大學(xué)內(nèi)分泌二科、運(yùn)動(dòng)醫(yī)學(xué)科就診及體檢中心體檢的580例病例,其中2型糖尿病200例(DM組),骨關(guān)節(jié)炎97例(OA組),2型糖尿病合并骨關(guān)節(jié)炎83例(DM合并OA組)及正常對(duì)照組(Normal control group,NC組)200例的一般臨床資料(年齡、性別、BMI、SBP、DBP)并檢測(cè)其生化指標(biāo)(FPG、空腹C肽、空腹胰島素(Fasting insulin,FINS)、HbA1c、TC、TG、LDL-C、HDL-C、Ca2+),計(jì)算 HOMA-IR、HOMA-β。采用SPSS22.0統(tǒng)計(jì)軟件對(duì)上述研究對(duì)象相關(guān)指標(biāo)的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,比較四組間各指標(biāo)差異性,并分析上述指標(biāo)在不同疾病患者血清中的差異及意義。[結(jié)果](1)NC組、DM組、OA組、DM合并OA組四組間兩兩比較年齡、性別均無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。(2)DM組和NC組在BMI、SBP、DBP、FPG、空腹C肽、空腹胰島素、糖化血紅蛋白、Ca2+、HOMA-IR、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在TC、HDL-C無(wú)統(tǒng)計(jì)學(xué)意義(P值0.05)。(3)OA組與NC組在BMI、Ca2+、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在SBP、DBP、空腹胰島素、TC、TG、LDL-C、HDL-C、HOMA-IR 無(wú)統(tǒng)計(jì)學(xué)差異(P 值0.05)。(4)DM合并OA組與NC組在BMI、SBP、DBP、FPG、空腹C肽、空腹胰島素、糖化血紅蛋白、TG、LDL-C、HDL-C、Ca2+、HOMA-IR、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在TC無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。(5)DM組與OA組在BMI、FPG、空腹C肽、糖化血紅蛋白、TC、TG、LDL-C、Ca2+、HOMA-IR、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在SBP、DBP無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。(6)DM合并OA組與DM組在BMI、空腹胰島素、糖化血紅蛋白、LDL-C、Ca2+、HOMA-IR、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在DBP、SBP、FPG、空腹C肽、TC、TG、HDL-C無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。(7)DM合并OA組與OA組在BMI、FPG、空腹C肽、空腹胰島素、糖化血紅蛋白、TC、TG、LDL-C、Ca2+、HOMA-IR、HOMA-β均有統(tǒng)計(jì)學(xué)差異(P值0.05),在SBP、DBP、HDL-C無(wú)統(tǒng)計(jì)學(xué)差異(P值0.05)。(8)Logistic回歸分析結(jié)果提示:糖化血紅蛋白、BMI、HOMA-IR可能是糖尿病患者OA發(fā)生的危險(xiǎn)易感因素;空腹C肽、Ca2+則可能是糖尿病患者OA發(fā)生的保護(hù)性因素。[結(jié)論]DM合并OA組糖、脂、Ca2+代謝紊亂及胰島素抵抗水平最嚴(yán)重,血壓及BMI升高水平也最明顯;糖化血紅蛋白、BMI、HOMA-IR可能為糖尿病患者發(fā)生0A的危險(xiǎn)因素;空腹C肽、Ca2+則可能為保護(hù)性因素,提示血糖控制達(dá)標(biāo)、減輕體重及補(bǔ)充鈣劑可能延緩或阻止DM患者OA發(fā)生,可為糖尿病骨關(guān)節(jié)炎的預(yù)防和治療提供新的思路。[目的]探究血管內(nèi)皮生長(zhǎng)因子(Vascular endothelial growth factor,VEGF)、成纖維細(xì)胞生長(zhǎng)因子2(Fibroblast growth factor 2,FGF2)、結(jié)締組織生長(zhǎng)因子(Connective tissue growth factor,CTGF)、轉(zhuǎn)化生長(zhǎng)因子-β(Transforming growth factor-beta,TGF-β)在2型糖尿病伴骨關(guān)節(jié)炎發(fā)生、發(fā)展中的作用及相關(guān)性,為糖尿病骨關(guān)節(jié)炎的臨床診斷與治療提供理論依據(jù)。[方法](1)收集2014年10月至2016年12月在昆明醫(yī)科大學(xué)內(nèi)分泌二科、運(yùn)動(dòng)醫(yī)學(xué)科就診的380例病例,其中200例2型糖尿病(DM組),97例骨關(guān)節(jié)炎(OA組),83例2型糖尿病合并骨關(guān)節(jié)炎(DM合并OA組)及體檢中心體檢的200例正常健康對(duì)照組(Normal control group,NC組)的空腹血2-3ml。(2)采用ELISA方法檢測(cè)血清中血管生成因子(VEGF、FGF2、CTGF、TGF-β)水平。(3)應(yīng)用SPSS22.0統(tǒng)計(jì)軟件對(duì)上述研究對(duì)象相關(guān)指標(biāo)進(jìn)行統(tǒng)計(jì)學(xué)分析,比較四組間各指標(biāo)差異性及血管生成因子(VEGF、FGF2、CTGF、TGF-β)濃度,分析上述因子在不同疾病患者血清中濃度的差異。[結(jié)果](1)2型糖尿病組、骨關(guān)節(jié)炎組、2型糖尿病合并骨關(guān)節(jié)炎組血清VEGF、FGF2、CTGF、TGF-β檢測(cè)水平均較正常對(duì)照組升高,且2型糖尿病合并骨關(guān)節(jié)炎組比2型糖尿病組和骨關(guān)節(jié)炎組升高更明顯(P0.01)。(2)Pearson相關(guān)性分析結(jié)果提示:VEGF、FGF2、CTGF、TGF-β均與年齡、空腹血糖及糖化血紅蛋白呈正相關(guān)關(guān)系(P0.05),其余指標(biāo)與4種血管生成因子則均無(wú)相關(guān)性。(3)Logistic 回歸分析示:VEGF(OR=1.263)、FGF2(OR=1.105)、CTGF(OR=1.327)、TGF-β(OR=1.212)為糖尿病患者OA發(fā)生的危險(xiǎn)因素。(4)VEGF、FGF2、CTGF、TGF-β的ROC曲線面積分別為為0.811、0.865、0.736、0.795,對(duì)糖尿病合并骨關(guān)節(jié)炎診斷準(zhǔn)確性均屬中等。[結(jié)論]2型糖尿病合并骨關(guān)節(jié)炎組血清VEGF、FGF2、CTGF、TGF-β 4種血管生成因子高表達(dá)共同參與糖尿病骨關(guān)節(jié)炎的發(fā)生、發(fā)展,有望通過(guò)阻斷或抑制其生成預(yù)防或治療糖尿病骨關(guān)節(jié)炎。單純通過(guò)檢測(cè)某一種因子的濃度作為OA早期診斷的指標(biāo)其靈敏度和特異度還有待進(jìn)一步研究。
[Abstract]:[Objective] to explore the role and correlation of general data and biochemical indexes in the development of type 2 diabetes with osteoarthritis (knee joint), and to provide a theoretical basis for the clinical diagnosis and treatment of diabetic osteoarthritis. [Methods] to collect the two Department of Endocrinology and the medical examination center of the sports medicine department from October 2014 to December 2016 in Kunming Medical University. 580 cases of physical examination, including 200 cases of type 2 diabetes (group DM), 97 cases of osteoarthritis (group OA), 83 cases of type 2 diabetes with osteoarthritis (DM combined with OA group) and 200 cases of normal control group (Normal control group, NC) and 200 cases of general clinical data (age, sex, BMI, SBP, DBP) and their biochemical indexes (FPG, fasting peptide, fasting insulin) Lin, FINS), HbA1c, TC, TG, LDL-C, HDL-C, Ca2+), calculate HOMA-IR, HOMA- beta. Use SPSS22.0 statistical software to analyze the data related to the above objects, compare the differences between the four groups, and analyze the difference and significance of the above indexes in the sera of the patients with different diseases. There was no statistical difference in sex between the four groups (P value 0.05). (2) there were statistical differences between group DM and NC in BMI, SBP, DBP, FPG, fasting C peptide, fasting insulin, glycosylated hemoglobin, Ca2+, HOMA-IR, HOMA- beta (P value 0.05). (3) there were statistical differences (3) Value 0.05), there were no statistical differences in SBP, DBP, fasting insulin, TC, TG, LDL-C, HDL-C, HOMA-IR (P value 0.05). (4) DM combined OA group and NC group in BMI, fasting insulin, glycosylated hemoglobin, there were no statistical differences (0.05). (5) (5) group and group In BMI, FPG, fasting C peptide, glycosylated hemoglobin, TC, TG, LDL-C, Ca2+, HOMA-IR, HOMA- beta, there were statistical differences (P value 0.05), and there were no statistical differences in SBP (6). There was no statistical difference in HDL-C (P value 0.05). (7) there were statistical differences between OA group and OA group in BMI, FPG, fasting C peptide, fasting insulin, glycosylated hemoglobin, TC, TG, LDL-C, Ca2+, and there was no statistical difference (8). (8) regression analysis suggested that glycosylated hemoglobin It is a risk factor for the occurrence of OA in diabetic patients; fasting C peptide and Ca2+ may be a protective factor for the occurrence of OA in diabetic patients. [conclusion]DM combined with group OA, glucose, lipid, Ca2+ metabolism and insulin resistance is the most serious, and the level of blood pressure and BMI increase is also most obvious; glycosylated hemoglobin, BMI, HOMA-IR may be the 0A of diabetic patients. Risk factors, fasting C peptide and Ca2+ may be protective factors, suggesting that blood glucose control is reached, weight loss and calcium supplement may delay or prevent the occurrence of OA in DM patients, which can provide new ideas for the prevention and treatment of diabetic osteoarthritis. [Objective] explore the vascular endothelial growth factor (Vascular endothelial growth factor, VEGF) and fibroblast Cell growth factor 2 (Fibroblast growth factor 2, FGF2), connective tissue growth factor (Connective tissue growth factor, CTGF), transforming growth factor - beta (Transforming growth factor-beta) in type 2 diabetes with osteoarthritis, development and relevance, for the clinical diagnosis and treatment of osteoarthritis of diabetes For the theoretical basis. [method] (1) to collect 380 cases of medical treatment in the Endocrinology Department of Kunming Medical University from October 2014 to December 2016, including 200 cases of type 2 diabetes (group DM), 97 cases of osteoarthritis (group OA), 83 cases of type 2 diabetes combined with osteoarthritis (DM combined with OA) and 200 normal healthy controls (Norm Al control group, NC group) 2-3ml. (2) using ELISA to detect the levels of serum angiogenic factors (VEGF, FGF2, CTGF, TGF- beta) in serum. (3) use SPSS22.0 statistical software to carry out statistical analysis on the related indexes of the above subjects, and compare the concentrations of angiogenic factors and angiogenic factors between the four groups. The difference in serum concentrations of these factors in patients with different diseases. [results] (1) the levels of VEGF, FGF2, CTGF and TGF- beta in the serum of type 2 diabetic group, type 2 diabetes and osteoarthritis group were higher than those in the normal control group, and the increase of type 2 diabetes combined with osteoarthritis was more obvious than that of the type 2 diabetes group and the osteoarthritis group (P0.01). (2) Pearson correlation analysis showed that VEGF, FGF2, CTGF, and TGF- beta were all positively related to age, fasting blood glucose and glycosylated hemoglobin (P0.05), and the other indexes were not correlated with the 4 kinds of angiogenic factors. (3) Logistic regression analysis showed that VEGF (OR= 1.263), FGF2 (OR=1.105), CTGF (CTGF) were diabetic patients. (4) the ROC curve area of VEGF, FGF2, CTGF, TGF- beta was 0.811,0.865,0.736,0.795, and the diagnostic accuracy of diabetes combined with osteoarthritis was moderate. [conclusion the high expression of serum VEGF, FGF2, CTGF, TGF- beta of the serum of type]2 diabetes combined with osteoarthritis group was involved in the onset of osteoarthritis of diabetes. It is expected that it is expected to prevent or treat diabetic osteoarthritis by blocking or inhibiting its formation. The sensitivity and specificity of a single factor only by detecting the concentration of a certain factor as an early diagnostic indicator of OA remains to be further studied.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.1;R684.3

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